Gallery: South Sudan - Decentralised healthcare in Upper Nile State

13 February 2018

In South Sudan’s northeastern Upper Nile State medical care for people living in remote areas is practically non-existent. Years of civil war and budget cuts have led to chronic underfunding and a near collapse of pre-existing medical structures.

MSF is providing decentralised medical outreach services to some of the most isolated places in the region, like Dethok or Oriny, from our main hospitals in the State.

Basic medical care is provided in the villages, with serious cases referred to either Malakal hospital - which lies roughly 70km up the White Nile river - or to Aburoc field hospital. Both are run by MSF teams.

Isolated villages like Dethok have been spared from much of the violence associated with the war, but they have also been left with little access to medical care.

South Sudan: MSF leaves for Dethok village at the crack of dawn

Photo: Philippe Carr/MSF

The outreach team to Dethok village sets off in a Land Cruiser at first light. Security is a major issue as fighting is recurring in the area so travelling at night is impossible. The town of Dethok is only 17km from Aburoc hospital, but it can take more than three hours to cover this distance.

Introducing the team

Photo: Philippe Carr/MSF

The team includes drivers, a logistical coordinator, a doctor, a nurse and a community health advisor.

With the help of a tractor

Photo: Philippe Carr/MSF

Passing through certain areas is only possible with the help of a tractor which tows the Land Cruiser. Halfway along the road the team comes across a wide swamp that can only be passed with the tractor.

Cattle camps on the route

Photo: Philippe Carr/MSF

As the team follows its route, cattle camps can be seen on either side of the road. In the local culture, livestock is highly prized and typically it is the older men and younger children who tend to the animals.

Meeting the village elders

Photo: Philippe Carr/MSF

Meeting the local community leaders is essential. Without their support MSF will not have permission to come to the village. The council of Dethok is eager to hear from MSF as we provide much-needed care.

MSF arrives at the health post in Dethok

Photo: Philippe Carr/MSF

Once the team arrives in Dethok, the health post is prepared. Local community leaders have been given advance notice of our arrival to spread the word to the whole village and surrounding areas. Within a few minutes there are more than forty people awaiting a consultation.

Patients arrive with a multitude of different problems

Photo: Philippe Carr/MSF

Those that arrive have a multitude of different problems, from broken fingers, to strokes, to diabetes. What is clear is that, for most of them, their conditions are somewhat neglected. For many, the arrival of MSF is a lifeline. Despite the long wait, everybody gets to see a doctor or nurse.

A medical system that relies on humanitarian support

Photo: Philippe Carr/MSF

The clinic in Dethok is under-supplied. As with most of the medical infrastructure in South Sudan, there is little money for investment in facilities, staff or medicines. Donations from NGOs are essential, as are visits by MSF.

Around the village

Photo: Philippe Carr/MSF

Around the village most houses are empty, as people are working in the fields or tending to their cattle.

Malaria testing in one go

Photo: Philippe Carr/MSF

Malaria is one of the leading causes of illness and mortality in South Sudan, yet in most rural areas there is little in terms of preventative measures or the necessary treatment. In Dethok the team are able to take blood tests and supply the necessary medication for those suffering from the disease.

Severe cases are referred to our hospitals

Photo: Philippe Carr/MSF

One woman, who has had a possible stroke, is brought by stretcher to the post. A decision is made by the medical team that she needs to be brought to MSF’s Malakal hospital as her situation is critical. The doctor decides that she can’t travel by road as the ride is too rough. Instead a boat is rented from the local fishermen and the next day they travel. The woman’s family explains that they would have tried to carry the woman on their back to the hospital at Aburoc had the team not arrived.

Leaving Dethok is not easy

Photo: Philippe Carr/MSF

Leaving the village is difficult as people come to the mobile clinic gradually over the course of the day. But by 3pm it is essential that the convoy leaves. For security reasons the team needs to be back in the base before nightfall. They tell the community elders that they will be back in a weeks' time.

Returning to base

Photo: Philippe Carr/MSF

Once the team returns from Dethok, their regular jobs start. They all have full-time roles in the hospital and their presence is essential for the well-being of patients.